10D2311158 CLIA NUMBER - VISAGE DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 10D2311158
  • Facility Name: VISAGE DERMATOLOGY
  • Facility Address: 5013 96TH ST E
    PALMETTO, FL
    ZIP 34221
  • Facility Phone: 727 388-6982
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: ALEXANDRIA S. KONGSIRI
  • NPI Number: 1932200045
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 10D2311158
LAB Type Physician Office
Facility Name VISAGE DERMATOLOGY
Street 5013 96TH ST E
City PALMETTO
State FL
ZIP 34221
Phone 727 388-6982
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Physician Office
Lab Director ALEXANDRIA S. KONGSIRI

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This page was last updated on: 9/29/2025